ICD-10 Education and Outreach Successful; Work Remains for Medicaid Testing

The Government Accountability Office (GAO) reported Friday that a majority of stakeholders believe that ICD-10 educational and outreach activities by the Centers for Medicare & Medicaid Services (CMS) have been helpful in preparing for the Oct. 1, 2015 compliance deadline, but work remains for states to complete testing of the own systems prior to the transition.

“A successful transition to ICD-10 codes requires every healthcare provider, clearinghouse, and payer to prepare in advance of the October 1, 2015, transition deadline,” wrote the GAO in its report, “CMS’s Efforts to Prepare for the New Version of the Disease and Procedure Codes.” The report was submitted to the U.S. Senate Committee of Finance, which requested that the GAO study actions undertaken by CMS and highlighted within cited support the transition of HIPAA entities from ICD-9 to ICD-10.

”CMS has taken multiple steps to help prepare covered entities for the transition, including developing educational materials and conducting outreach, and the majority of the stakeholders we contacted reported that both of those activities have been helpful to preparing covered entities for the ICD-10 transition,” the GAO noted.

The GAO also reported that CMS has developed educational materials, such as checklists and timelines. Moreover, the GAO noted that CMS has conducted outreach to prepare covered entities for the transition by holding in-person training for small physician practices in some states.

“CMS officials have also monitored covered entity and vendor readiness through stakeholder collaboration meetings, focus group testing, and review of surveys conducted by the health care industry,” the GAO noted in its statement.

CMS told the GAO that its Medicare fee-for-services claims processing systems have been updated for ICD-10 codes, according to internal testing conducted by CMS. However, the GAO noted, there is uncertainty as to whether what, if any, changes might be necessary, based on the agency’s ongoing external testing activities.

External testing was on the minds of respondents who recently expressed to the GAO that they were concerned that CMS’s testing activities had “not been comprehensive,” according to the results of a survey. In response, CMS cited that it had scheduled end-to-end testing with 2,550 covered entities during three weeks in January, April, and July of this year.

On the other hand, Medicaid testing appears to be problematic.

“Medicaid agencies reported that they would be able to perform all of the activities that CMS has identified as critical by the transition deadline, as of November 2014, (although) not all agencies have started to test their systems’ abilities to accept and adjudicate claims containing ICD-10 codes,” the GAO noted.

“Last week’s GAO report sends a strong message that CMS has stayed on track with provider outreach and testing in support of our industry’s transition to ICD-10 in October 2015,” said Chris Powell, CEO of Precyse, a provider of health information management solutions and staunch advocate for ICD-10. “We and others in the industry — spanning providers, payers and the vendor community — have been working for many years and will continue to drive forward to reach the very achievable implementation deadline, (implement) this update, and (react in accordance with) the supportive announcements from Capitol Hill (that) indicate we will move forward without further delays.”

It was a topic that even U.S. Senate Finance Committee Chairman Orrin Hatch (R-Utah) weighed in on in the GAO report.

“As demonstrated by this report, the provider outreach and responsiveness to stakeholder concerns from CMS have kept the agency on track to upgrade to the next level of healthcare coding,” Hatch said. “While additional testing will be needed to ensure its success, the transition to the new system will streamline the management of healthcare records and improve patient care. I will continue to keep a close eye on this issue but see no reason for any delay past the October deadline.”